How the cancer grows

Cervix is the lower most part of the uterus or the mouth of the uterus that dips into the vagina. In a normal state, the cervix constantly changes in response to fluctuating hormonal levels.

The tissues in our body have a predetermined growth. Exposure to carcinogenic [cancer causing] factors can trigger abnormal growth in tissue cells. As a result, these cells do not perform their functions optimally, grow in an unruly fashion and spread beyond their requisite boundaries.

The Human Papilloma Virus [HPV] is responsible for causing cervical cancer. Usually, an infection of this virus clears on its own. However, if it persists, it can cause cervical cancer. HPV may also cause genital warts, cancers of the vulva and vagina. Genital warts are lump-like growths in the genital region. As the disease progresses, one may notice abnormal vaginal bleeding, bleeding between periods, or after sexual contact and increased white discharge that may be foul smelling.

Who is at risk?

All sexually active women, across all segments of society are at risk. However, there are certain preventable factors that add to the risk.

• Early sexual exposure, either through premarital sex [which is often clandestine, and therefore, without any protection] or because of an early marriage. This exposes the girl to loads of infections. The risk is higher in such cases, because at this age the body is not always mature or healthy to fight infections.
• Anaemia adversely affects immunity. In case of Indian women, this can be an important influencing factor as nearly 70 per cent – 80 per cent women in India have haemoglobin levels below 11g/dl.
• Frequent termination of pregnancy, especially using over-the-counter medications and emergency contraceptives. This adds to the risk because even though the pregnancy is terminated, the hormonal changes in the cervical tissues increase the susceptibility to infections.
• Repeated pregnancies and sexually-transmitted infections.
• Smoking increases a woman’s risk of developing precancerous and cancerous conditions.
• Lack of proper personal hygiene, poor nutrition and absence of contraception make a woman susceptible to infections.

All the above situations act as an ideal milieu for the HPV virus to thrive.

How to prevent the cancer

All it takes to prevent this cancer is regular screening and vaccination.

Screening

Women should regularly screen themselves with Pap smear, which involves testing naturally shed cervical cells on a slide and staining them. The test is reliable and helps detect the disease in its precancerous stage, when the treatment is simple and may not require surgery.

Ideally, women should start screening by Pap smear within three years of becoming sexually active and continue every three years till the age of 65 years. Women who find this option cumbersome should at least test themselves once at 35 years of age or after that [recommends the World Health Organization].

Two other simple tests that give instant results are the VIA [Acetic acid] or VILI [Lugol’s iodine].

In these tests, the cervix is smeared with diluted acetic acid or Lugol’s iodine and examined for a precancerous condition. These are done by gynaecologists or trained health workers and are comparable alternatives to the Pap test. In case the tests results are positive and the doctor suspects a precancerous lesion, the woman is subjected to colposcopic examination. A colposcope is a device that enables examining the cervix through a magnified lens. The affected tissue is then either excised for biopsy or cauterised.

The HPV DNA test is the current gold-standard in cervical cancer screening and can detect the presence of high-risk HPV types covering more than 95 per cent of the cervical cancer cases. It is USFDA approved and has more than 300 publications to support its strength and utility. It involves collecting the specimen from the cervix with a small brush-like tool, which is then used to detect the HPV DNA. The collection procedure takes less than five minutes.

If the test results are negative, there is a negligible risk of cancer with an amazing 99.7 per cent certainty and can reduce the screening interval to once in 3 – 5 years. If the test results are positive, there is an increased risk of progression due to the presence of high-risk HPV. An immediate follow-up is essential to treat the disease before it becomes cancerous. A repeat test may be advised in 12 months.

HPV DNA is recommended for women who are 30 years of age or older. It is done for primary screening and also in case of abnormal/inconclusive Pap smear results or cervical disease to determine the follow-up procedures. The test beats the disadvantages posed by other currently available tests in the market.

Vaccination

Two types of vaccines, are available in the Indian market for cervical cancer [Ask your doctor for details]. Vaccination is given in three doses over a period of six months [offers lifelong immunity]. For the best protection, it is important to get all the three doses of the vaccination as per schedule. Vaccination also protects the women against HPV infections from different strains of the virus that might cause cervical cancer in the future. However, regular screening should be continued after vaccination to offer best possible protection against the cancer.

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These are physiological changes. But there can also be some pathological alterations due to some underlying disease in the woman, which is not diagnosed or has become overt during the pregnancy.

These need to be investigated thoroughly as clinical examination alone may not be sufficient to detect them.

Hence, she needs to undergo some basic tests. Undergoing these tests also help ease the anxiety of most expectant moms, who keep worrying about the healthy progress of their pregnancy.

1. Haemogram for anaemia

As soon as a woman realises she is pregnant, it is important to get her blood haemoglobin level checked to rule out anaemia. Haemogram gives the complete blood count, which can give information about other parameters like the white cell count, platelet count and abnormalities if any.

The normal haemoglobin of a pre-pregnant woman should be 12g per cent. A haemoglobin count less than 10g per cent at the onset of pregnancy is anaemia and can cause several untoward consequences like growth restriction in the baby, infections in the mother, and dire changes in the cardiovascular system.

Nutritional anaemia is the commonest type of anaemia encountered. But some women may have other reasons to become anaemic such as thalassemia and sickle cell disease, which are further investigated if the haemoglobin level is found to be low or high.

Also, as the pregnancy progresses, blood gets diluted due to increase in its fluid content. The degree of this dilution needs to be assessed and therefore the test is repeated in the later months.

2. Sugar for diabetes

It is mandatory to screen pregnant women for diabetes. You could either do a random blood sugar level test or a test with oral glucose. This helps in identifying the disease, which can adversely affect the mother and the foetus.

3. TSH levels for thyroid

Thyroid screening [by checking your Thyroid Stimulating Hormone [TSH] levels] is essential because a thyroid abnormality can retard the growth of the baby.

If it comes positive, further thyroid evaluations are suggested to determine the exact cause of the abnormality as each type has a different affliction on the pregnancy outcome.

4. Serological tests for several diseases

Serological tests are done to screen for certain disease carrier states as they are known to cross the placental barriers and infect the foetus. The tests include VDRL for syphilis, Tridot test for HIV-AIDS and HBsAg for hepatitis B. These diseases are transmitted through close physical contact and therefore the father-to-be is also screened if the mother is found positive.

5. Rhesus factor for compatibility

It is essential to know the blood group of the mother. If a mother’s blood group is negative, there is a possibility of developing problems during pregnancy.

Rhesus [Rh] antigen is an important antigen on the red blood cells, which determines the positive or the negative blood group of an individual. If the mother is Rh negative and the father is Rh positive, there is a 50 per cent chance of incompatibility in the pregnancy, which can result in anaemia and jaundice. Such a mother is periodically subjected to some tests such as the indirect Coomb’s test, sonographic examinations, and colour Dopplers to determine the progress of the pregnancy.

6. Urine tests for infections

The urine is checked regularly for detecting infections and proteins. Presence of proteins in the urine indicates infection. Infections are common in pregnancy and can affect it adversely. Such infections can exacerbate and affect the urethras and the kidneys. Screening of this condition is therefore regularly done throughout the pregnancy.

7. TORCH and other tests

In addition, there are tests such as the first trimester screening and the triple tests for uncovering abnormalities in the foetus. In these, a combination of hormones and antigenic markers are checked from the blood sample and then graphically evaluated.

Some viral infections such as Toxoplasmosis, Rubella, Cytomegalovirus and Herpes [TORCH] are known to cross the placental barrier and cause adverse effects on the foetus. These infections are assessed by performing the TORCH tests.

The sound technology

Ultrasound examination [USG] is a non-invasive technique that uses sound waves. It does not involve any radiation and is harmless. USG in pregnancy, helps to assess the following:

• Location of pregnancy—inside or outside the uterus.
• Growth of the pregnancy—whether it corresponds to the derived duration.
• Signs of early stages of pregnancy, which cannot be clinically determined.
• The number of babies.
• The location of the placenta inside the uterus.
• Structural abnormalities in the baby.
• Biometric measurements of the baby to assess weight and growth restriction.
• The fluid around the baby.
• The blood flow in the various important blood vessels of the baby and the mother.
• The position of the baby.

USG examinations are done:

• In the first three months: to establish the correct baseline duration of the pregnancy.
• Between 18 – 24 weeks: To detect any structural abnormalities.
• 28 – 32 weeks: To assess the interim growth of the baby.
• 36-term: To assess foetal wellbeing and determine the biophysical profile.

In addition, the doctor may advise USG examination in situations where there are complaints such as pain, bleeding, and if s/he suspects growth restriction of the baby.

Advanced planning is key

The tests mentioned above are all basic screening tests. In situations when the mother-to-be is positive to a particular screening test or is clinically suspected to have a disease, further detailed evaluation is mandatory.

Ideally, a woman should visit a doctor even before she stops a contraceptive. The doctor can then properly evaluate her physical condition, order relevant tests [if necessary], recommend folic acid supplements and ensure a healthy pregnancy.

This was first published in the May 2011 issue of Complete Wellbeing.

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Ideally, in the first two months. This is to help date the pregnancy correctly. It also helps in early diagnosis of abnormalities like a molar pregnancy, twin pregnancy, or a pregnancy occuring outside the uterus.

Are frequent sonographies harmful to the baby? How many sonographies are considered safe?

A sonography is not radiation. It is a non-invasive technique, which uses high-frequency sound wave impedance against tissues to evaluate internal structures. Hence, it is harmless. Ideally, sonographic evaluations are to be performed as follows:

• First trimester dating ultrasonography [USG] around eight weeks.
• Between 18 – 22 week to detect structural abnormalities in the baby and to know the placental location.
• During 28 – 32 weeks for growth assessment by biometric measurements and assessment of the liquor around the baby.
• Between 38 – 40 weeks for biophysical profile to assess the growth and the capability of baby to safely face labour.

In addition to these, a scan is performed at 11 weeks in certain special situations for assessment of nuchal translucency [the thickness on the babies neck], which is a soft tissue marker for trisomies—chromosomal abnormalities such as the Down’s syndrome.

Also, scans are necessary to assess growth more frequently if there have been any episodes of bleeding or leaking of water. In addition, colour doppler studies to examine the perfusion of the baby and the placenta may be suggested. A foetal 2D echo may be requested to evaluate the baby’s condition in special situations.

If I am healthy and eat a well-balanced diet, should I still take prenatal vitamins?

Yes, you may need to take these medicines as proper assimilation of the diet that you are taking is not assured. Plus requirements of certain mineral and micronutrients during pregnancy are increased and their absence can cause untoward consequences.

Are prenatal vitamins harmful to the baby if taken without a doctor’s consultation?

They are not harmful, but have to be consumed at the appropriate time. For instance, they are not to be consumed during the first three months. Consult your doctor, as only s/he can guide you about these things.

Which foods should I avoid during pregnancy?

You should avoid unclean, spicy, stored, stale and pickled foods. Also abstain from foods containing excessive sodium [salty foods], and foods that have no nutritive value and that offer only empty calories [refined food like pastries, bread].

What alterations should I make in my daily schedule once I know I am pregnant?

The changes are both physical as well as psychological.

• Avoid stress and strain of any kind—strenuous exercise/work or thought that triggers stress.
• Allot a fixed time for physical fitness—it could even be just a walk.
• Get adequate rest and sleep.
• Do not engage in any kind of substance abuse.
• Think positive thoughts and enjoy your pregnancy.

Are spa/beauty/hair treatments to be completely avoided during pregnancy?

When you are pregnant, the skin turgidity is increased due to water retention. So, it is best to avoid engaging in too many tightening facials and massages. Also, refrain from undergoing sudden temperature variations as in a sauna. Further, if you use a hair dye, test it for allergic reaction before applying it.

What can I do to manage the common symptoms like nausea and cramps?

Nausea usually subsides by the end of the third month of pregnancy. Consume dry foods like biscuits and dry fruits during this time. Always maintain normal blood sugar level with small frequent feeds.

For cramps, ensure an adequate calcium supply to your body by consuming lots of fluids, fresh vegetable, fruits. Walking helps too. But if you don’t get any of the above symptoms, don’t worry; it doesn’t mean that there are complications.

Can having sex during pregnancy harm the baby?

No, it does not harm the baby. There are, however, certain situations when the doctor may advise you to abstain from sex for a specific period.

How soon should I begin planning for labour and delivery?

Mentally, you must plan for it from the time you get pregnant. Financial planning for the expenses of hospital stay also should start well in advance. Apart from that, you should prepare for labour and delivery in the last month of your pregnancy.

Does travelling by bus/train/taxi/auto harm the baby?

No. It does not.

Are prenatal therapies like yoga, acupressure and massage helpful or harmful?

Every thing can be practised and is safe as long as it is done in moderation and under correct guidance.

What precautions need to be taken in the workplace?

Like I mentioned earlier, you should have a healthy environment and avoid stress of any kind. Stay away from colleagues who are not well, avoid crowded places and consume healthy food and water.

Can I go on vacations or long trips when pregnant? Any precautions to be taken?

It’s best avoided. If you still go, be very careful about food and cleanliness. Go to a place where medical help is easily accessible. Strenuous adventurous trips such as scuba diving, trekking should not be undertaken.

Will exposure to eclipses, metal detectors, UV rays, X rays and so on have an adverse effect on the baby?

Avoid exposure to X-rays and UV rays.

The post Pregnancy: What exactly should I expect? appeared first on Complete Wellbeing.

Get yourself checked

A lot of attention is paid to the physical fitness of the mother-to-be and rightfully so. Any situation, which digresses from a normal healthy situation may turn into an untoward occurrence during pregnancy. These possibilities need to be identified and therefore prenatal or antenatal check-ups become important. These check-ups are directed towards monitoring maternal as well as foetal wellbeing and prediction of any untoward occurrence.

For example identifying patients at risk of having abortions, pregnancy-related hypertension, anaemia or intrauterine growth restriction of the baby or at least identifying any such risk at the earliest. Diabetes, thyroid abnormalities, anaemia and reduced oxygen carrying capacity of the blood are common in India.

Evaluate before planning

Thus, physical fitness encompasses the basic health status of the mother, which ideally should be evaluated before a pregnancy is planned. In most cases, the woman realises that she is pregnant after 6 – 8 weeks. By this time the neural tube of the baby [from which the brain and the spinal cord develops] is already formed. If the mother has inadvertently consumed any medicines, is on any therapy or has inadequate consumption of folate in her diet, the growing foetus may develop some life-threatening complications.

This also is the period when the placenta [organ which supplies nutrition to the baby from the mother] is formed. If this is improperly developed, it may not function effectively, thus resulting in intrauterine growth restrictions. Therefore, it is imperative for women to seek medical advice before conception to assess their physical fitness levels for pregnancy.

Once the pregnancy is confirmed, the doctor advises certain tests to evaluate the health status of the mother and baby.

Know if you are ready

The most important aspect of antenatal [pre-pregnancy] care is to identify risk category and prevent adverse outcomes as much as possible. Pregnancy is best if it is well planned—knowing whether it is truly your priority now and if you are ready for it.

Just ask yourself some simple questions—am I physically fit for this pregnancy? Are my BMI and haemoglobin levels normal? What is my blood group? Am I anaemic? Do I have regular menstruation? Am I taking any medication, which may need to be changed when planning a baby? Am I taking folic acid supplements and a well-balanced diet? Consult your gynaecologist who will help evaluate yourself better.

Eat right and work it out

Once you are pregnant, you have to be extremely careful about what you eat. During the first three months, many women suffer from nausea and a dislike towards food. But you can overcome this by some simple measures:

• Eat small frequent meals, which are not fried or spicy.
• Drink plenty of fluids and eat fresh fruits, and sprouts.
• Never fast when you are pregnant as you have to eat regularly throughout the day to supply energy to the fast-multiplying cells in your body. Fasting causes release of ketones, which form as a result of muscle breakdown and is not the right energy source for the metabolism of the baby’s cells.

Once nausea wanes [mostly after the fourth month], the tolerance towards food increases. The caloric content of food has to be approximately 2400 kcal of which 30 – 40 per cent should be proteins. Eat complex carbohydrates such as whole wheat and unpolished rice, avoid refined carbohydrates. Make milk, milk products and other protein sources such as pulses, eggs, meat a regular part of your diet. You will require about 1200mg of calcium and roughly about 500g of roughage per day.

In spite of an adequate diet intake you still need to take iron, calcium and folate supplements as these have been proved to be highly beneficial for a healthy pregnancy.

Physical exercise is equally important during pregnancy. It helps enhance general well-being, increase the flexibility of the mother’s body and improve blood circulation. It also helps tone the body and regularise appetite. Adequate exercise also can act as a great mood elevator and this helps in a positive pregnancy. Continue with the regular activities that you were doing before pregnancy, but avoid extreme levels of physical exertions.

Get friendly with the hormones

Pregnancy is associated with a lot of hormonal upheaval in your body. There are a lot of physiological adaptations that the body undergoes during pregnancy, which prepare your body for child birth and lactation thereafter.

Just accept all the changes and relax as these are temporary changes and easily reversible at a later stage. These hormonal changes are responsible for the emotional ups and downs—feelings of elation to extreme sense of insecurity and depression. These are to be expected and therefore dealt with by not indulging into these thoughts. Pregnancy is a passing phase and these emotional upheavals also pass. There has to be a constant effort to create a positive attitude, and this is completely self-dependent.

Make it special

Pregnancy is not a result of a moment of lust. It has to be a much wanted result of culmination of love and should be understood as such. Every baby should be wanted by the mother and the mother should go out of her way to make the pregnancy feel precious. It entirely is her emotions, physical fitness and her psyche that finally will help result in a healthy outcome. The realisation and understanding that through motherhood, you are a part of a much larger destiny is important.

A healthy mind within a healthy body, which is stable and intertwined to deliver the best for the birth of the baby is what you need to strive for.

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